As we discussed in Module 1, panic attacks are surges of intense anxiety and fear. In panic disorder, panic
attacks seem to occur unexpectedly and cause considerable distress.
The aim of this InfoPax module is to provide you with some more detailed information on how panic
attacks actually develop. This module will also describe how panic attacks develop into panic disorder and
what treatment strategies may be useful.
How do panic attacks happen?
In Module 1, we discussed how a panic attack can be described as a “false alarm”; a spontaneous surge of
fear without a real, physical threat. You might be wondering why panic attacks happen.
A particular person may have an initial panic attack (a false alarm) for a complex mixture of reasons. This
mixture probably includes a person’s biological make-up, their personality, and the tendency for the body
to initiate a fear response. While these factors provide the setting for the possibility of a panic attack, one
thing that often sets the stage is a person’s experience of stress. Many people recall that their first panic
attack happened after a stressful period in their lives, such as after negative life events, or relationship
difficulties, or significant loss. In people who have a greater likelihood of experiencing the fear response,
going through this kind of stress can make a panic attack more likely. So for some people then, their
physical response to negative events may be similar to how they would respond to physical danger – as a
threat to their well being.
At other times, panic attacks may begin to build when there is an internal or external trigger that is
perceived as threatening. External triggers may be situations in which you feel a little apprehensive. For
example, going into a room that feels stuffy, or onto a train, or in a supermarket from which it may difficult
to escape. You can probably think of a few situations right now in which you often feel apprehensive.
Internal triggers might be thoughts, images, memories, and even bodily sensations. These triggers may be
ordinary events until you interpret them as somehow threatening. For example, have you ever felt tightness
in your chest, felt your heart beat faster, and thought “What’s wrong with me?” - which then leaves you
feeling quite anxious? Remember, it is our belief that something is threatening that leads to anxious feelings.
When we perceive a situation, thought, image or a sensation as
somehow threatening, we begin to feel anxious or apprehensive.
So, when we start to feel anxious, we may notice some physical
changes, such as, accelerated heart rate, shortness of breath,
tightness in the chest, dizziness, etc. Normally these signs of
anxiety will soon subside or fade away on their own if the threat
is not a real one. However, what do you think would happen if,
before these sensations subside, you start worrying intensely
about the meaning of those sensations, such as thinking it might be
a heart attack, or perhaps, that you are losing control or going
crazy? Such thinking would add to your fears and in response your
anxiety would continue to build up? You can probably guess that
this extra layer of thinking produces a rush of increasing anxiety and it’s “PANIC STATIONS!”.
Think about it this way: what do you think would happen if you started thinking that you were going to
have a heart attack or going to faint? Your anxiety about these anxious sensations would probably increase,
which makes the anxiety sensations stronger, which would increase your anxiety about those sensations,
and so on. You can probably see where this situation is leading. The anxiety would rise so quickly that a
“panic attack” would result.
• Psychotherapy • Research • Training
Module 2: More about Panic